Understanding Rumination Disorder: Symptoms, Causes, and Treatment
A Closer Look at a Lesser-Known Eating Disorder
While most people are familiar with eating disorders like anorexia nervosa or bulimia, fewer are aware of Rumination Disorder — a rare but serious feeding and eating disorder that often goes undiagnosed or misunderstood. Individuals with rumination disorder experience repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out — and it’s not due to a medical condition or reflux.
Whether you're a caregiver, clinician, or someone seeking answers for yourself or a loved one, understanding the symptoms, causes, and treatment of rumination disorder is essential to providing compassionate care and effective intervention.
What Is Rumination Disorder?
Rumination Disorder is characterized by:
Repeated regurgitation of food for at least one month
The behavior is not due to a gastrointestinal or medical issue (like GERD or reflux)
The behavior is not better explained by another eating disorder, such as anorexia or bulimia
It causes significant distress, social impairment, or nutritional consequences
Rumination typically occurs within 30 minutes of eating and is not preceded by nausea or involuntary vomiting. The regurgitation is often effortless and may be described as "bringing up food in the mouth."
Who Can Be Affected by Rumination Disorder?
Rumination disorder can occur in:
Infants (usually resolving on its own)
Children (especially those with developmental disabilities)
Adolescents and adults, though this population is less commonly recognized
In older individuals, rumination disorder may be misdiagnosed as:
An eating disorder (e.g., bulimia, due to similar behaviors)
A gastrointestinal condition
An anxiety-related issue
It’s often underreported due to stigma, shame, or the private nature of the behavior.
Signs and Symptoms of Rumination Disorder
Behavioral Symptoms:
Repeated regurgitation of food after eating
Re-chewing or spitting out the regurgitated food
Avoidance of eating in public due to fear of regurgitation
Attempting to self-induce regurgitation for relief
Absence of nausea or illness associated with vomiting
Physical Symptoms:
Bad breath or sour taste in the mouth
Stomach discomfort or bloating
Weight loss or failure to thrive (in children)
Nutritional deficiencies or dehydration (in chronic cases)
Dental erosion or damage to the esophagus (in severe cases)
What Causes Rumination Disorder?
There is no single cause, but several contributing factors may include:
In Infants:
Often developmental or self-soothing
May be triggered by neglect, overstimulation, or stress
Frequently resolves with improved caregiving and stimulation
In Older Children, Teens, and Adults:
Habitual behaviors developed after a GI illness or stress
Anxiety or trauma leading to maladaptive coping
Reinforcement cycle: relief from discomfort leads to repetition of behavior
Association with other disorders: may co-occur with anxiety, OCD, autism spectrum disorder, or intellectual disability
In some cases, the behavior begins involuntarily and becomes compulsive or soothing, similar to self-stimulatory behaviors.
How Is Rumination Disorder Diagnosed?
Diagnosis is based on:
A thorough clinical interview and observation of symptoms
Medical rule-out: testing to eliminate other causes (e.g., reflux, gastroparesis)
Use of behavioral assessments in feeding clinics or by specialists in eating/feeding disorders
Clinicians will also assess for:
Co-occurring psychiatric disorders
Nutritional status and medical complications
Social or occupational impairment due to symptoms
Early identification is key, especially in children, to prevent complications and minimize behavioral reinforcement.
Treatment for Rumination Disorder
Effective treatment involves a multidisciplinary approach, often including medical, psychological, and nutritional support.
1. Behavioral Interventions
The most evidence-based treatments use habit-reversal strategies, including:
Diaphragmatic breathing during and after meals to interrupt the regurgitation reflex
Postural and environmental changes (e.g., upright positioning, calm meals)
Meal supervision and structured routines
Positive reinforcement for non-regurgitative behavior
Biofeedback or cognitive-behavioral interventions in older children and adults
2. Medical Support
Rule out or treat gastrointestinal issues that may worsen symptoms
Monitor hydration, weight, and nutritional intake
In some cases, medications (such as antispasmodics) may be used to reduce GI discomfort
3. Psychotherapy
CBT can help address the emotional or compulsive aspects of the behavior
Anxiety management or trauma therapy if underlying stressors are present
For co-occurring developmental disorders, applied behavior analysis (ABA) may be included
4. Family Involvement
Especially in children and adolescents, family education and support are critical:
Understanding the disorder helps reduce shame and punishment
Families can reinforce treatment goals and provide a structured, supportive environment
Prognosis and Outlook
The prognosis for rumination disorder varies depending on:
Age of onset
Presence of developmental disabilities
Speed of diagnosis and treatment
Family and environmental support
With early and consistent intervention, many individuals can significantly reduce or eliminate symptoms. For others, management may be ongoing but can greatly improve quality of life and nutrition.
Final Thoughts
Rumination disorder may be lesser known, but it is real, treatable, and deserving of attention and support. Like all feeding and eating disorders, it is not a choice — and recovery is possible with understanding, structure, and care.
If you or someone you love is experiencing symptoms of rumination disorder, know that help is available. Early intervention can make all the difference.
Resources
Feeding Matters – Support for pediatric feeding disorders: www.feedingmatters.org
National Eating Disorders Association (NEDA) – Information and referrals: www.nationaleatingdisorders.org
Academy for Eating Disorders (AED) – Education and provider resources: www.aedweb.org
American Academy of Pediatrics – Guidelines on feeding and eating disorders in children and adolescents
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
Chial, H. J., Camilleri, M., Williams, D. E., Litzinger, K., & Perrault, J. (2003). Rumination syndrome in children and adolescents: Diagnosis, treatment, and prognosis
